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This report focuses on two questions of current interest to policy makers. First, “What percent of U.S. families experience financially burdensome health expenses?” and, second, “What are the determinants of financially burdensome health expenses among U.S. families?” The first question is addressed by examining how the distribution in. the United States of families with financially burdensome health expenses is affected by six different possible measures of financial burden. The second question is addressed by using multiple regression techniques on one of the measures selected as a preferred measure. The data used are from the family data files of the 1980 National Medical Care Utilization and Expenditure Survey (NMCUES). This report presents data on approximately 5,000 multiple-person families interviewed in this longitudinal survey. It provides a separate analysis for each of three socioeconomic family populations that have consistently been of interest to policymakers. These are (1) older families (defined for this report as all U.S. multiple-person families with a member 65 years of age or over); (2) younger, lower-income families (defined as all U.S. multiple-person families below 200 percent of the poverty level in 1980 and with all members under 65 years of age); and (3) younger, better-off families (defined as all U.S. multiple-person families at 200 percent of the poverty level or higher in 1980 and with all members under 65 years of age). Two general conceptual approaches have been used in the literature to assess financially burdensome health expenses. The first approach measures financial burden by the size of a family’s health bill in dollars. The second approach focuses on a family’s ability to pay its health bill, and it measures financial burden as a ratio of health expenses to family income. There is no agreement on which of the two approaches is preferable and also no agreement on which of several operational measures in each category is the most appropriate. In order to shed light on this controversy, this report compares six potentially useful operational measures of financial y burdensome health expenses. Three are dollar measures and three are ratio measures, The three dollar measures are (1) total charges for health care (irrespective of who pays the bill or whether or not the bill is paid), (2) out-of-pocket expenses for health care services (family-paid premiums for health insurance are not included), and (3) total out-of-pocket expenses for health (the previous measure plus out-of pocket premiums). The three ratio measures use the three dollar measures to construct measures involving a ratio of expenses to total family income. This gives (1) the ratio of total charges for health care to family income, (2) the ratio of out-of-pocket expenses for health care services to family income, and (3) the ratio of total out-of-pocket expenses for health to family income. Given these measures, the question still remains as to what level of expense, or ratio of expense to income, constitutes a financially burdensome expense. The usual practice in the literature has been to use several different thresholds arbitrarily selected from the upper part of the particular expense distribution under examination, and this practice is followed in this report. The overall finding for the six measures was that different results were found for the different measures even when the same threshold was used.

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